Endocrine Abstracts

Introduction: Hyperparathyroidism is uncommon during pregnancy with less than 200 cases reported worldwide. Untreated, this condition can result in a 20–30% incidence of fetal death and 50–60% incidence of complications during pregnancy. If recognized early, the condition is treatable with significant improvement in fetal and maternal outcomes.

Case: We report the case of 35-year-old asymptomatic Asian female (gravida 9 para 4, one stillbirth) whose diagnosis and management is a clinical challenge. Osteomalacia was diagnosed after her newborn child suffered neonatal tetany in 2002 and investigations revealed the mother to have a low calcium of 2.08 mmol/l, low phosphate of 0.59 mmol/l, alkaline phosphatase 199 u/l, PTH 429 ng/l, low 25 OH vitamin D of 0 pg/ml, and low 1,25 Hydroxy Vit-D of 7 g/ml. Treatment with calcium and vitamin D was commenced, however compliance over the years was poor. In 2002 she represented again in pregnancy and was noted to have elevated calcium and PTH.

Investigations including both an isotope and ultrasound scan of neck were normal leading to a diagnosis of tertiary hyperparathyroidism. She was reviewed by surgeons who felt intervention would not be beneficial at this stage. She became pregnant again in 2007 with calcium levels around 3 mmol/l but unfortunately lost the baby at 28 weeks.

Discussion: Osteomalacia diagnosed during or post pregnancy in Asian women is not unusual, however this lady went on to develop tertiary hyperparathyroidism, perhaps as a result of non-compliance. Hyperparathyroidism is known to cause complications during pregnancy including fetal death as in this case. Given the young age of this patient should we have been more aggressive when considering surgery to eliminate the problem and was our original diagnosis correct?